Automated monitoring of movement disorders in dyskinetic cerebral palsy during powered mobility

Background Dyskinetic cerebral palsy (DCP) is dominated by dystonia and choreoathetosis, two movement disorders that are often simultaneously present and challenging to evaluate. Wearable technology shows potential for monitoring motor dysfunctions at high temporal resolution while expanding our understanding of DCP movement disorders.

This study aimed (i) to develop a methodology for automatic classification of dystonia and choreoathetosis combining inertial measurement units (IMUs) and random forests (RFs) during powered wheelchair driving in participants with DCP, (ii) to determine signature features for dystonia and choreoathetosis, and (iii) to optimise placement of body-worn IMUs in function of dystonia and choreoathetosis classification performance.

Unconstrained movements of the arms and head during powered mobility (n = 5 DCP participants) were analysed to extract 111 time- and frequency-domain features in 5-second windows. RFs were then used to rank, select optimal features and classify dystonia and choreoathetosis, based on expert-annotated videos.

Classification of dystonia and choreoathetosis for the neck, proximal and distal arm regions ranged within 67.8% - 80.7% accuracy. Reduced feature sets included between 19 - 73 features, as time-domain features were selected more prevalently in classifying both dystonia and choreoathetosis. IMUs on the distal arms predicted forehead dystonia and choreoathetosis with similar accuracy (74.5% - 81.2%) as using the forehead IMU.

This study increases insights into DCP by relating distinct IMU features to dystonia and choreoathetosis and by leveraging distal arm-placed IMUs to assess movement disorders in multiple body parts: distal arm, proximal arm and neck region. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study was funded by the C3 grant from the Research Council of KU Leuven, C32/17/056 Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the Medical Ethics Committee UZ KU Leuven and conducted in accordance with the Declaration of Helsinki. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes ↵¥ Shared first authorship The authors declare no conflict of interest concerning the current research. This study was made possible by a C3 grant from the Research Council of the KU Leuven University, C32/17/056. Data Availability All data produced in the present study are available upon reasonable request to the authors.